Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Conisbrough Group Practice on 10 October 2016. Overall the practice is rated as outstanding.

Our key findings across all the areas we inspected were as follows: 

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, the practice was accredited by the NHS National Institute for Health Research as a research active practice and a GP had undertaken good clinical practice training. The practice was participating in 12 separate research studies with academic organisations.  
• Feedback from patients about their care was consistently positive.
• The practice worked closely with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, the GPs developed a new person-centred appointment system, implemented in October 2015. The new system offered continuity of care whilst ensuring those who needed an appointment received one. 
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example, following feedback from patients an assisted opening mechanism was installed to the door at the back of the practice to promote independence for those using the parking spaces to the rear of the building.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw several areas of outstanding practice including:

• The person centred appointment system worked by asking the patient if their concern was new, did they consider it urgent and who would they usually see. Patients we spoke with and written comments reported a significant improvement in accessing a GP, particularly offering choice and continuity of care. Some reported it was not always necessary to see a GP and their query could be dealt with over the telephone.
• The new model of access was published in the Royal College of General Practitioners Bright Ideas magazine. Staff from other practices in the area and from further a field had visited the practice to see the system in operation with a view to implementing it.
• Two of the partners formed the practice in 2001 by taking over a single handed practice with no regular GP. Over the next 15 years they took on another four single handed GP practices, following a series of GP retirements, to provide services from one purpose built health centre. We were shown the original comprehensive business plan which had been reviewed and developed over the years to support the vision and values. The plan captured the areas originally identified for improvement and outcomes detailed how they were achieved. This demonstrated a long term shared purpose, commitment to support, develop and motivate staff to succeed.
• There was a commitment to developing staff in any area which might have a benefit to patients  This included those working in the practice and for other healthcare providers. For example healthcare assistants were supported to undertake spirometry testing and GPs mentored an orthopaedic practitioner in the primary care environment. The GPs also offered mentorship to practice nurses from other surgeries in the area completing the nurse prescribing course. Administrative apprentices were supported to develop their skills which led to permanent employment at the practice.
• Staff were supported to have roles within the wider community. For example, one of the GPs was a University Lecturer and Clinical Teacher in primary care. Three GPs were GP trainers and another undertaking GP training. Another was involved in scoping the provision of primary care in Doncaster and looking at new ways of working. The practice had also been approached to support other practices in the area.

The areas where the provider should make improvement are:

• Introduce a procedure to track electronic prescriptions through the practice as per NHS Protect Security of prescription guidance 2013.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice